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A post published Oct. 15 on Suze Orman’s website says many people with substantial retirement savings ask: “If I have $5 million or more, do I really need long-term care insurance?” (1)
The answer, written in Orman’s voice: “It’s a fair question, but retirement savings and long-term care insurance are not competing goals. One builds your future, and the other helps protect it.” (1)
She’s right about the risk. The federal government’s long-term care website, last updated in 2020, says “Someone turning age 65 today has almost a 70% chance of needing some type of long-term care services and supports in their remaining years.” (2)
Medicare won’t pick up that bill. Medicare.gov says flatly, “Medicare doesn’t pay for long-term care.” (3)
And it’s expensive. CareScout’s 2025 Cost of Care Survey put the national median for a private nursing home room at $129,575 a year. (4)
I’ve been a CPA since 1981, and I agree with most of what Suze says about long-term care insurance. Where I part ways is that $5 million household. Here are five things to know before you buy.
1. Suze is right that timing matters
Orman’s post says that “for many people, the ideal time to explore long-term care insurance is between ages 45 and 60.” Her reason is simple: “Waiting generally means higher premiums.” (1)
That’s good advice. If you’re in your 50s and haven’t at least priced a policy, do it now.
One place to do it is Money.com's long-term care insurance comparison page, covering services like home care, assisted living, and help with daily tasks.
Long-term care insurance isn’t cheap, and if you’re already older, may not be affordable. But you should take a minute and see what your options are. See a list of the best LTC insurance companies — takes 2 minutes.
2. The odds are real, but so is the range
That 70% figure gets quoted a lot. The rest of the government’s estimate matters just as much.
Women need care longer than men — 3.7 years versus 2.2 years. One-third of today’s 65-year-olds may never need long-term care support, but 20% will need it for longer than five years. (2)
That’s the textbook case for insurance. The average need is painful. It’s the long one that can wipe out a family’s savings.
3. With $5 million, you may be able to be your own insurance company
Here’s where I disagree with Suze’s answer to that question.
Let’s run the numbers. At the 2025 median of $129,575 a year, spending all 3.7 of those years in a nursing home would cost about $479,000. (4) That’s less than 10% of $5 million.
Stretch it to five years, and the bill is about $648,000 — roughly 13% of $5 million. Costs are likely to rise over time, so are savings. Either way, that’s a big bill, not a ruined retirement.
Orman’s post frames the decision as “deciding how much financial risk you want to keep and how much you want to transfer.” (1) In my view, a household with $5 million can usually afford to keep that risk, and skip a lifetime of premiums.
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4. The people who need it most are in the middle
At the other end of the scale is Medicaid. Medicare.gov says that for Medicaid, “Most often, eligibility is based on your income and personal resources,” and that programs vary from state to state. (5)
It also notes that “Most people who enter nursing homes start by paying for their care out-of-pocket.” (5)
Here’s my read: If you have very little saved, Medicaid is likely your backstop. If you have millions, you can probably pay your own way.
It’s the folks in between — with a few hundred thousand to a couple million dollars — who have the most to lose, and the most to gain from a policy.
5. Don’t let the premium wreck the rest of your plan
On this point, Suze and I are in full agreement. Her post says, “Reduce retirement contributions only if absolutely necessary.” And: “Do not use your emergency fund to pay for coverage.” (1)
If you’d hate paying premiums for decades and never using the coverage, the post, relaying advice from long-term care insurance specialist Phyllis Shelton, notes that “There are also plans available today with guaranteed premiums that provide a death benefit if long-term care is never needed.” (1)
Those policies are worth comparing. Just read the fine print, and know exactly what you’re paying for.
My honest take
Suze gets the big picture right: Long-term care is a risk that’s easy to ignore, and Medicare won’t save you.
But insurance exists to cover bills you can’t pay on your own. If your savings could cover this one without changing how you live, a policy may be a luxury, not a necessity.
Know which group you’re in. If you can pay the bill yourself, you’re already the insurance company.
Sources: 1. Suze Orman; 2. Administration for Community Living; 3. Medicare.gov; 4. CareScout; 5. Medicare.gov
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